My training objectives for this K01 Career Development Award are to enhance my knowledge and experience in a) prescription drug and alcohol interactions among older adults;b) alcohol and substance abuse;and c) developing, implementing, and examining a community-based health intervention program. These training goals will support me in reaching my long-term career objective to become an expert in interventions for health behavior change among older adults to reduce inadvertent prescription drug use adversities. This will be accomplished through randomized community-based behavioral trials, and designing and implementing awareness and motivational interventions. The ultimate goal of this K01 Career Development Award project is to support my development as an independent scientist capable of conducting community-based behavioral health intervention that will reduce alcohol-prescription drug interactions in rural older patients who regularly take prescription medications. The impetus behind this K01 Career Development Award application is the need for effective interventions to address the devastating health effects of prescription drug and alcohol interactions. Prescription overdoses that require medical attention in older adults are commonly associated with alcohol. In combination, alcohol and prescription drug misuse can seriously undermine the medical condition that is being treated by the prescription drug medication, lead to potential alcohol drug interactions, increase the risk fo alcohol and illicit drug use, and ultimately increase health costs. In the training component of th proposed program, I will gain a more thorough understanding of principles surrounding prescription drug safety (PDS), alcohol interactions, and community-based health interventions. Specifically, my efforts will focus on understanding PDS by targeting the reduction of prescription drug and alcohol interactions in rural pharmacy settings. The proposed project will focus on older adults in rural settings because they are at high risk for prescription misuse, in addition to having limited resources for managing PDS issues. The proposed research will involve the development, implementation, and evaluation of an intervention in a community setting designed to improve PDS through a) raising awareness about alcohol use and prescription drug interactions and b) using motivational interviewing to reduce alcohol consumption among at-risk alcohol consumers (consuming above recommended age-defined limits (>1 alcoholic drink a day in combination with prescription drugs). Prescription drug safety is characterized by consuming correct quantities and avoiding prescriptions in combination with adverse substances (e.g., alcohol), to prevent negative health outcomes. This K award will be a platform for the development of expertise but also a novel, promising, and wide reaching approach to prevent prescription drug interactions through community-based prevention methods targeting modifiable behaviors in community pharmacies. Promoting moderate alcohol use patterns to encourage safer use of prescription drugs is significant since approximately 50% of older adults consume alcohol, of whom 25% consume more than the recommended age-defined limits. Additionally, older adults use prescription drugs more than any other age group. Risky alcohol consumption (the age-defined definition involves consuming more than 1 drink/day on average) can have negative interactions with many medications commonly used by older adults, and consequently, can have detrimental impacts on health. These health effects include medication and disease-management non-adherence, and increased likelihood of falls, cognitive impairment, medical adversities, and fatality. The proposed study will involve the implementation of an intervention in community settings with the aid of local pharmacists, and will include an awareness and motivational interviewing component to promote PDS. Specific Aims of the research proposal are to 1) Obtain community insights about PDS, to examine rural resources/barriers, which will inform the development of the PDS intervention program;2) Create PDS intervention material for the awareness and motivational interviewing components, 3) Implement and evaluate intervention components (Awareness and Motivational Interviewing) to promote PDS in rural regions, and 4) Disseminate findings and develop an R01 NIH grant to examine the proposed intervention on a larger scale. Achieving the proposed aims will lead to an innovative approach to promote PDS within other rural communities. Establishing an effective PDS intervention will reduce adversities related to prescription drug and alcohol interactions for older adults and consequently improve their quality of life.

Public Health Relevance

This research will aid in reducing the rates and consequences of prescription drug and alcohol interactions among older adults residing in rural US areas. Reducing prescription drug and alcohol interactions can ultimately reduce individual and societal health burden and improve life quality through improved cognition and mental and physical capabilities.